Organerhalt beim fortgeschrittenen Larynx‑/Hypopharynxkarzinom: Erfahrungen aus der DELOS-II-Studie

Organ preservation in advanced laryngeal/hypopharyngeal carcinoma: lessons from the DeLOS-II trial

Zusammenfassung

Bei Erkrankten mit lokoregionär fortgeschrittenen Larynx- und Hypopharynx-Plattenepithelkarzinomen (LHSCC) gibt es diejenigen, die für die funktionelle Erhaltung des Larynx (LP) gewisse Risiken in Kauf nehmen und eine ablative Operation unbedingt vermeiden wollen, und diejenigen, die aufgrund hinreichender Argumente einer operativen Larynxentfernung den Vorzug geben. Derzeit richtet sich die Therapie nach Patientenbedürfnissen und -wünschen, Erfahrung und Empfehlung des Chirurgen, Philosophie der Einrichtung usw. Die als „Meilenstein“ geltende VA-Studie etablierte erstmals in den 1990er-Jahren eine nichtchirurgische LP bei fortgeschrittenem LHSCC unter Induktionschemotherapie (IC) mit PF (Cisplatin, P, + 5-Fluoruracil, F) und anschließender Bestrahlung (IC + RT) als geeignete alternative Behandlung zur kompletten Laryngektomie (TL). Obwohl die Ergebnisse der VA-Studie durch die EORTC-24891-Studie für das Hypopharynxkarzinom verifiziert wurden, wird weiterhin über das beste Protokoll bezüglich Überleben und laryngektomiefreiem Überleben (LFS) mit akzeptabler Spättoxizität und gutem funktionellem Ergebnis diskutiert. Bei fortgeschrittenem LHSCC ohne chirurgische Optionen zur Larynxerhaltung werden aktuell eine IC + RT oder eine primäre platinbasierte simultane Radiochemotherapie (CRT) als Behandlungsoptionen zur funktionellen LP akzeptiert. In den USA wird ausschließlich die CRT als bestes kuratives LP-Protokoll empfohlen. Aktuell wird in Bezug auf das Langzeitüberleben bei funktioneller Organerhaltung und unverändert hohen Rezidivraten die Notwendigkeit einer besseren Patientenauswahl unter Berücksichtigung der entsprechenden Literatur und v. a. der aktuellen Daten der DeLOS-II-Studie diskutiert.

Abstract

Patients with locoregionally advanced laryngeal and hypopharyngeal squamous cell carcinomas (LHSCC) comprise two broad groups: those who are candidates for functional larynx preservation (LP) with avoidance of ablative surgery and those who are not. Currently, treatment depends on the patient’s needs and wishes, the experience and recommendation of the surgeon, the philosophy of the institution, etc. The milestone VA trial established non-surgical LP in advanced LHSCC in the 1990s using induction chemotherapy (IC) with PF (cisplatin, P, plus 5‑fluorouracil, F) followed by irradiation (IC + RT) as an appropriate alternative treatment to total laryngectomy (TL). Even though the findings of the VA trial were verified by the EORTC 24891 trial, a debate persists regarding the best protocol for balancing survival and laryngectomy-free survival (LFS) with acceptable late toxicity and good functional outcome. In advanced LHSCC without surgical options for larynx preservation, only IC + RT or primary concurrent platin-based chemoradiotherapy (CRT) are accepted treatment options aiming to preserve a functional larynx. In the US, cisplatin-based CRT is exclusively recommended as the best curative protocol. With regards to long-term survival with functional organ preservation and persistently high failure rates, there is current discussion on the necessity of improving patient selection based on the current literature and the recently published data of the DeLOS-II trial.

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Correspondence to Prof. Dr. A. Dietz.

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A. Dietz, G. Wichmann, T. Kuhnt und S. Wiegand geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Dietz, A., Wichmann, G., Kuhnt, T. et al. Organerhalt beim fortgeschrittenen Larynx‑/Hypopharynxkarzinom: Erfahrungen aus der DELOS-II-Studie. HNO (2020). https://doi.org/10.1007/s00106-020-00890-5

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Schlüsselwörter

  • Kopf- und Halsneoplasien
  • Kopf-Hals-Plattenepithelkarzinom
  • Kehlkopfkrebs
  • Hypopharynxkrebs
  • Induktionschemotherapie

Keywords

  • Head and neck neoplasms
  • Head and neck squamous cell carcinoma
  • Laryngeal cancer
  • Hypopharyngeal cancer
  • Induction chemotherapy